Thursday, January 17, 2008

Morgellonian Mania

A scrawny young man visited my Emergency Department several years ago complaining of thousands of tiny bugs crawling over and under his skin.* This sensation had been progressing for weeks and had driven him to a frenzy of nervous activity. He was covered with excoriated sores and streaks of scarlet - inflicted, I was sure, by his fingernails. I inspected him from head to toe but did not see any evidence of insect or parasite, but he was not deterred. He handed me a smudged envelope and asked me to (carefully) look inside. I pulled out a half dozen pieces of scotch tape, each of which had trapped a number of black-brown specks. These specks were the bugs, he declared, and he dared me to prove otherwise by looking at them under magnification. Although I was quite sure that he was wrong, I humored him, and took a real close look under a magnifying glass. And while I didn't see any signs of movement or of anatomic structure, I was perplexed as to the source of these small dark specks. They seemed too slim to be dirt and too irregular to be sand. After several minutes of debate, during which my patient demanded answers and I challenged his theory but failed to offer an alternative explanation, I noticed something. His fingernails were crusted, outside and under the tip of the nail, with a black-brown substance that looked like..."Are you a painter?" I asked him. Well, yes, of course he was and while I was pleased to have solved the mystery, my patient remained dubious. Nonetheless, I prescribed him a medication for itching and referred him to psychiatry with the presumed diagnosis of "delusional parasitosis."

I recalled this odd patient encounter yesterday as I was reading an article about a strange medical condition called Morgellons. This week, the CDC announced a $338,000 grant to Kaiser Permanente to study this "unexplained dermopathy," that some believe is caused by infection or toxic exposure but others believe is nothing more than a new name for the psychiatric condition known for seventy-five years as delusional parasitosis. In 2001-2002, biologist Mary Leitao took her two-year-old son to numerous doctors looking for an explanation for a strange skin condition: the sensation of bugs crawling and biting the skin associated with cutaneous sores that, upon close inspection, contained bundles of fine, multi-colored fibers. The doctors were either baffled, disinterested or skeptical and out of her frustration. Leitao found the inspiration to name her son's condition. She lifted the name Morgellons from a line in Thomas Browne's A Letter to a Friend (1690) that describes a "distemper of children...called the morgellons, wherein they critically break out with harsh hairs on their backs."

The key distinction between Morgellons and delusional parasitosis appears to rest with these bundles of fine fibers. What are they? Skeptics believe that they are textile threads from clothing scratched and rubbed into sores, but Leitao and thousands of others are convinced that there is some other source. Lyme disease has been fingered as a possible culprit, as have pesticides. Personally, I would have a much easier time writing off the Morgellons concept if it weren't for two aspects of the condition that don't fit cleanly into the realm of psychiatry: the hundreds of affected children and the geographic clustering of disease. I have seen plenty of adults, most of them psychotic or high on methamphetamine, who believing themselves infested, have scratched and clawed their skin raw. The patient I described above is a textbook example. But not children, and especially not young children like Andrew Leitao. And, there's the matter of clustering. Of the over 11,000 families that have registered with the Morgellons Research Foundation, 26% are in California and there appear to be disease clusters in Southern California, Texas and Florida. I have no doubt that some of these (self-diagnosed) Morgellonians are battling scabies, drug abuse or psychiatric illness, but I am not so sure they all are. And, I do hope that someday soon scientific research can define precisely what it is that is bugging these people.

*The medical term for this sensation is "formication";_ylt=AhhDGfMVAm8Qsz1bO430qPIR.3QA